Will the US ever lose its need for IMGs?

[ThreadMaker]

So we keep hearing about new medical schools opening up to keep up with the doctor shortage. So I was wondering, will the day ever come when the US will no longer be reliant on IMG's? Or do you think there will always be space for img's?

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[Thama]

New med schools continue to open with no expansion of residency slots in sight. Spots are already scarce for IMGs. Do the math.

 

[Birdstrike]

So we keep hearing about new medical schools opening up to keep up with the doctor shortage. So I was wondering, will the day ever come when the US will no longer be reliant on IMG's? Or do you think there will always be space for img's?

With millions more to be insured soon (supposedly) under Obamacare and no concrete plans to increase physician supply in the US, expect the demand for IMGs to increase significantly particularly in primary care, as will the need for PAs and NPs.

It's a good time to be thinking about being a PA, NP or IMG in my opinion.

 

[evilbooyaa]

With millions more to be insured soon (supposedly) under Obamacare and no concrete plans to increase physician supply in the US, expect the demand for IMGs to increase significantly particularly in primary care, as will the need for PAs and NPs.

It's a good time to be thinking about being a PA, NP or IMG in my opinion.

PAs and (especially) NPs, yes, based on the expansion of midlevels to become solo practitioners.

Not for IMGs. They will still require residency training, and with the increasing number of MD and DO schools, they will (in general) get squeezed out of all but the most unwanted locations in the most non-competitive specialties.

 

[Thama]

PAs and (especially) NPs, yes, based on the expansion of midlevels to become solo practitioners.

Not for IMGs. They will still require residency training, and with the increasing number of MD and DO schools, they will (in general) get squeezed out of all but the most unwanted locations in the most non-competitive specialties.

This is the fact that people who push going IMG either miss or attempt to hide. Demand in the marketplace doesn't matter here at all when the number of spots is artificially limited. Even if 50% of working physicians in every specialty retired next year the prospects for IMGs wouldn't be the slightest bit brighter without an increase in the number of residency positions, which doesn't appear likely at all right now.

 

[Mass Effect]

With millions more to be insured soon (supposedly) under Obamacare and no concrete plans to increase physician supply in the US, expect the demand for IMGs to increase significantly particularly in primary care, as will the need for PAs and NPs.

It's a good time to be thinking about being a PA, NP or IMG in my opinion.

What? You're encouraging people to be IMGs when so many of them don't match? PA and NP, yes. But IMG should be a last resort.

OP, was the U.S. ever reliant on IMGs or are you using it interchangeably with FMGs?

 

[ThreadMaker]

OP, was the U.S. ever reliant on IMGs or are you using it interchangeably with FMGs?

IMGs meaning people who graduated from foreign medical schools. And yes I thought IMGs and FMGs are the same thing.

I don't think the US was ever completely reliant on IMG's but there was a time when you could be a foreign medical graduate with a passing usmle score and have a pretty good change at residency and that's changing. I'm thinking it will one day be like Australia or Canada where getting a residency as a IMg is virtually impossible.

 

[ThreadMaker]

I think there is another thing to consider here. What if the number of residency spots did increase but then made it more difficult to find a job afterwards? Meaning what if you have a bunch of doctors who finished residency who can't find jobs?

 

[Birdstrike]

Not for IMGs. ...they will (in general) get squeezed out of all but the most unwanted locations in the most non-competitive specialties.

Like primary care.......?....

Yes. Which is what I said. That where they'll be needed (where they've always been needed) but more so as the uninsured gain greater access and enter the marketplace.

 

[Ronin786]

Does anybody envision a future where a FM residency ends up being half the time? Would that allow programs to increase the number of residents, helping mitigate the low numbers of PCPs?

Although I guess twice as many people would need to want to go into FM, easier said than done.

 

[Birdstrike]

What? You're encouraging people to be IMGs when so many of them don't match?

No.

Lets be clear. The question wasn't, "Should you become an IMG even if you have a chance to be a US medical graduate?"

The question was, "will the day ever come when the US will no longer be reliant on IMG's? Or do you think there will always be space for img's"?

Considering a significant number of IMGs have always been able to gain access through primary care specialties, you would expect that to continue as tens of millions of people without access to insurance, get it, and start needing primary care doctors when there is already a shortage and the US has made no preparations to train more.

In other words, if you are an IMG in the future, you'll be more in demand in the US than you are now. That is not to say that as an IMG you'll be in more demand than a US grad, because you won't be. It's two entirely different issues.

As a group, IMGs which always be more willing to go into primary care than an American grad with $300,000 in student loan debt. Such graduates have tended always to gravitate more towards higher paid specialties than primary care, which is why we have a glut of the former and a shortage of the latter.

 

[CDI]

What? You're encouraging people to be IMGs when so many of them don't match? PA and NP, yes. But IMG should be a last resort.

OP, was the U.S. ever reliant on IMGs or are you using it interchangeably with FMGs?

IMG is now the more politically correct term for an FMG. Doesn't matter if you're from a Caribb school or school in Asia.

The ones that have trouble matching are the ones who are from other countries with a Visa requirement and can't speak a lick of English and/or those who went to a no name Carib program, had trouble with exams and are just ruled out for being duds.

And yes the US was heavily reliant on IMGs...for decades. The stories I hear from IMG relatives are hilarious. Desperate PDs picking up IMGs at the airport, housing them, etc back in the day. Those courtesies are long gone. However, as a result of AMGs shunning certain programs, there are now IMG programs (where the PDs are IMGs too) which don't even bother ranking AMGs.

 

[Law2Doc]

With millions more to be insured soon (supposedly) under Obamacare and no concrete plans to increase physician supply in the US, expect the demand for IMGs to increase significantly particularly in primary care...

That's not really how it works. The issue has never been a shortage of demand. The issue is cost. The goal of the administration presently is to drive down costs as it adds more patients to the system. The way they will do that in part involves overtly NOT funding more residency slots, maybe even funding fewer. In other repects they may cut down funding for the higher end tests and procedures, meaning fewer spots in certain specialties -- They may reallocate more spots to primary care, which really just means more US educated budding cardiologists will have to end up being internists instead. It doesn't help people outside of what is rapidly becoming a closed system. So it's a very bad time to be an IMG with more US med grads in the system every year and a push to lower costs and reallocate US grads to tge spots that IMGs previously had a shot at. I do agree that the midlevels are in good shape, but that isn't the question.

 

[sazerac]

In less than four years the number of US-trained medical students will be greater than the number of residency slots available. The question really boils down to whether an American medical student would rather be unemployed (and attempt to rematch) than accept a lower-tier residency. I bet the answer is yes, Americans would rather be unemployed. Of course the match gets more competitive each year so that might be a poor career decision.

However, as a result of AMGs shunning certain programs, there are now IMG programs (where the PDs are IMGs too) which don't even bother ranking AMGs.

And that's always another possibility I alluded to in last year's match thread... IMGs taking over the PD positions and simply not ranking AMGs no matter what their qualifications. Since apparently this is already the case, the number of US residency slots realistically available to US medical graduates will dry up even sooner than expected.

 

[Law2Doc]

In less than four years the number of US-trained medical students will be greater than the number of residency slots available. The question really boils down to whether an American medical student would rather be unemployed (and attempt to rematch) than accept a lower-tier residency. I bet the answer is yes, Americans would rather be unemployed. Of course the match gets more competitive each year so that might be a poor career decision.



And that's always another possibility I alluded to in last year's match thread... IMGs taking over the PD positions and simply not ranking AMGs no matter what their qualifications. Since apparently this is already the case, the number of US residency slots realistically available to US medical graduates will dry up even sooner than expected.

I sure wouldn't bet my career on either of these two hypotheses (that US grads would rather be unemployed or that the number of IMGs becoming PDs will change te landscape). Most US grad suddenly realize a noncompetitive field isnt so bad once the loans come due, and most foreign trained PDs mostly want to impress their Chairman/Dean/hospital administrator by recruiting the most prestigious class of residents they can get, to enhance their own job security, more than they care about paving the way for struggling IMGs. If anything IMG PDs might be less likely to go out on a limb.

 

[DocBlin]

Why not compare "real" numbers by looking at the last 3 years of the MATCH. Has the % or real #'s of IMGs matching really changed yet? 2010 to 2013 - no not really.! Expect a drop in 2015, in my opinion.

 

[CDI]

I sure wouldn't bet my career on either of these two hypotheses (that US grads would rather be unemployed or that the number of IMGs becoming PDs will change te landscape). Most US grad suddenly realize a noncompetitive field isnt so bad once the loans come due, and most foreign trained PDs mostly want to impress their Chairman/Dean/hospital administrator by recruiting the most prestigious class of residents they can get, to enhance their own job security, more than they care about paving the way for struggling IMGs. If anything IMG PDs might be less likely to go out on a limb.

Error: you're assuming that the crappiest AMGs are still better than the top IMGs. Those IMG PDs will not be getting guys from JHU and HMS, they'll be from bumfark U and the IMGs will be the best from their countries with solid resumes.

 

[Law2Doc]

Error: you're assuming that the crappiest AMGs are still better than the top IMGs. Those IMG PDs will not be getting guys from JHU and HMS, they'll be from bumfark U and the IMGs will be the best from their countries with solid resumes.

No, I'm assuming that as the numbers of US grads continue upward, better caliber US grads will ultimately start considering these less competitive spots. So the choices will no longer be just IMG vs crappiest.

But yeah, I would argue that to the typical dean or hospital administrator, the guy who graduated from a US school he's heard of still looks better than someone from some offshore or foreign school he knows squat about, regardless of who is actually "better".

 

[evilbooyaa]

Like primary care.......?....

Yes. Which is what I said. That where they'll be needed (where they've always been needed) but more so as the uninsured gain greater access and enter the marketplace.

After SOAP, I would say (almost) every residency spot goes filled in this country. The issue is not with the lack of qualified residents. The issue to the physician shortage is the lack of residency spots to train all of these doctors (be it AMG or IMG) in family practice.

As the number of AMGs continues to go up, the number of IMGs matching will probably go down.

At this point, I would recommend that someone go PA or NP rather than going the IMG route.

 

[gutonc]

One thing that I think it's important to differentiate are US Carib grads vs foreign IMGs. The Carib (and Eastern European) grads are the ones that are going to start having the tougher time of it in the match. It's the foreign citizens from good schools in their home countries that will continue to have a decent chance of matching. Dual citizens that go "home" to places like India/Pakistan the UK and Western Europe will do almost as well as their AMG counterparts, just as they do now.

 

[CDI]

No, I'm assuming that as the numbers of US grads continue upward, better caliber US grads will ultimately start considering these less competitive spots. So the choices will no longer be just IMG vs crappiest.

But yeah, I would argue that to the typical dean or hospital administrator, the guy who graduated from a US school he's heard of still looks better than someone from some offshore or foreign school he knows squat about, regardless of who is actually "better".

No, just no. PDs don't become PDs cause they're incompetent and use such logic. First off what do Deans or hospital administrators have to do with selecting medical residency applicants? Secondly bottom tier AMG who failed Step 1 vs. top tier IMG with 260/260?

 

[ThreadMaker]

One thing that I think it's important to differentiate are US Carib grads vs foreign IMGs. The Carib (and Eastern European) grads are the ones that are going to start having the tougher time of it in the match. It's the foreign citizens from good schools in their home countries that will continue to have a decent chance of matching. Dual citizens that go "home" to places like India/Pakistan the UK and Western Europe will do almost as well as their AMG counterparts, just as they do now.

I'm not so sure about this. I think it's virtually agreed that foreign medical graduates without US citizenship do worse than US citizen imgs because of english and visa issues. If the US citizen has a fail on one of his boards then I would concur with you but I think a US citizen img regardless of where he trained will have a better chance than a foreign img.

Anyone agree with me on this or am I just fooling myself?

 

[CDI]

I'm not so sure about this. I think it's virtually agreed that foreign medical graduates without US citizenship do worse than US citizen imgs because of english and visa issues. If the US citizen has a fail on one of his boards then I would concur with you but I think a US citizen img regardless of where he trained will have a better chance than a foreign img.

Anyone agree with me on this or am I just fooling myself?

You don't need anyone else to agree. Look at the stats. US-IMG match rate vs. non-US IMG match rate = +6-7%, used to be 9% before pre-matches got nearly eliminated in the regular match.

 

[Law2Doc]

No, just no. PDs don't become PDs cause they're incompetent and use such logic. First off what do Deans or hospital administrators have to do with selecting medical residency applicants? Secondly bottom tier AMG who failed Step 1 vs. top tier IMG with 260/260?

Working at a hospital is very political -- PDs get to where they are because they know how to work the politics and keep their Chirmn/Deans/administrators/trustees happy. It has less to do with competence or logic. And nobody outside of the PDs office ever sees the Step 1 scores. (I'm going to ignore your extremes because few PDs are ever actually are forced to decide between an AMG who failed versus an IMG with 260. Most of the time it's more like an AMG with 200 versus an IMG with 230. And it's rarely a one dimensional binary analysis based just on Step 1 scores, which, while used as an initial hurdle, are universally agreed not to be a useful measure of how good a resident someone will be). And yes the AMG will win these analysis, even if his stats are lower, because when the PD shows his list of residents to his bosses, and he will, they don't include these stats, just where they graduated from. The guy from U of State X looks better than the guy from some program the Chairman has never heard of. I think you are imagining a situation where the PD has unfettered authority to do whatever he wants without any bosses input or oversight, but those situations tend not to exist. He may have a long, sometimes imperceptible leash, but it's still there and if the PD objectively doesn't do a good job, and cow tow to the politicos, the leash tightens and the department head will give the job to someone else.

As I've stated in other threads, the analysis has little to do with quality. Rather it's about brand. In the US the AMGs are the trusted brand. The LCME ensures this by making US grads and schools jump through various hoops. Foreign grads, though they may have better stats don't come with this warranty. When you go to Best Buy to get a new TV, you might narrow your choices down to a Sony or some brand you never heard of that seems to have more bells and whistles for the same price. Guess what -- most people are still going to buy the Sony. Doesn't matter if it's the best or the best deal. You've heard of it. You know at you are getting. And this is the hurdle all IMG/FMGs face. Nobody cares if you have better Step 1 scores. PDs want to be able to hand a list of matched residents and their med schools to their bosses with lots of Sonys. That's how they keep their bosses happy. That's how they stay on the long leash. And in the end that's a more important motivator to them than offering a helping hand to someone outside this increasingly closed system.

 

[CDI]

Working at a hospital is very political -- PDs get to where they are because they know how to work the politics and keep their Chirmn/Deans/administrators/trustees happy. It has less to do with competence or logic. And nobody outside of the PDs office ever sees the Step 1 scores. (I'm going to ignore your extremes because few PDs are ever actually are forced to decide between an AMG who failed versus an IMG with 260. Most of the time it's more like an AMG with 200 versus an IMG with 230. And it's rarely a one dimensional binary analysis based just on Step 1 scores, which, while used as an initial hurdle, are universally agreed not to be a useful measure of how good a resident someone will be). And yes the AMG will win these analysis, even if his stats are lower, because when the PD shows his list of residents to his bosses, and he will, they don't include these stats, just where they graduated from. The guy from U of State X looks better than the guy from some program the Chairman has never heard of. I think you are imagining a situation where the PD has unfettered authority to do whatever he wants without any bosses input or oversight, but those situations tend not to exist.

As I've stated in other threads, the analysis has little to do with quality. Rather it's about brand. In the US the AMGs are the trusted brand. Foreign grads, though they may have better stats aren't. When you go to Best Buy to get a new TV, you might narrow your choices down to a Sony or some brand you never heard of that seems to have more bells and whistles for the same price. Guess what -- most people are still going to buy the Sony. Doesn't matter if it's the best or the best deal. You've heard of it. You know at you are getting. And this is the hurdle all IMG/FMGs face. Nobody cares if you have better Step 1 scores. PDs want to be able to hand a list of matched residents and their med schools to their bosses with lots of Sonys. That's how they keep their bosses happy. And in the end that's a more important motivator to them than offering a helping hand to someone outside this increasingly closed system.

No. They keep their bosses happy by not having to fire incompetent or unstable residents.

AMGs applying to these programs are equivalent to a black & white analog Sony TV and they don't come with warranties.

"Bossman, we hired a couple of suspect-at-best AMGs. We'll probably have to babysit them though and maybe fire a couple. Can I get a pat on the back?"

"Bossman, we hired an IMG group with Step 1 & 2 scores one SD above the US average, and several are already established physicians from their countries. Similar to last years group. Can I keep my job?"

 

[Obnoxious Dad]

No. They keep their bosses happy by not having to fire incompetent or unstable residents.

AMGs applying to these programs are equivalent to a black & white analog Sony TV and they don't come with warranties.

"Bossman, we hired a couple of suspect-at-best AMGs. We'll probably have to babysit them though and maybe fire a couple. Can I get a pat on the back?"

"Bossman, we hired an IMG group with Step 1 & 2 scores one SD above the US average, and several are already established physicians from their countries. Similar to last years group. Can I keep my job?"

It pains me to agree with Law2Doc, but he's right.

Over the past 10 years we have seen approximately 3,000 new US allopathic medical school seats and 2,500 new seats in osteopathic med schools. There has been an increase of approximately 2,500 residency slots leading to board certification. Even with a 10% med school attrition rate that means that there are 2,500 fewer slack residency slots. American medical school graduates, who have reasonable expectations about their residency choices, all get a residency slot. This leaves about 2,500 fewer slots for FMGS and IMGS.

 

[Doctor Bob]

PDs want to be able to hand a list of matched residents and their med schools to their bosses with lots of Sonys.

And often times it doesn't come down to a decision between an AMG and an IMG because many programs, early in the process, screen out the IMG applications and won't even look at them.

There is a prestige component to this process as well... we know that prospective medical students will be looking at our resident list in a few years and if our residents come from University of Phoenix or DeVry, our program will be viewed as less prestigious than if our residents came from US universities with recognizable names. The perceived prestige is what allows us to draw from a higher qualified group of applicants in the future.

 

[dozitgetchahi]

No, just no. PDs don't become PDs cause they're incompetent and use such logic. First off what do Deans or hospital administrators have to do with selecting medical residency applicants? Secondly bottom tier AMG who failed Step 1 vs. top tier IMG with 260/260?

There is this ongoing perception that every single FMG that applies to US residencies is some brilliant superstar applicant who would make William Osler himself proud. This perception is rubbish. There are many, many FMGs that apply with weak stats, and until fairly recently many of them actually did match. Furthermore, many of the FMGs who do match are really nothing special clinically (and yes, I've dealt with quite a number of them between med school and residency).

Secondly, there is certainly a cultural factor that you're overlooking. There is nothing surprising whatsoever about the fact that PDs prefer people who are familiar with/fluent in the US cultural milieu. Many PDs have been burned by FMGs who looked great on paper but turned out to be arrogant, uncooperative douchebags in person.

By your reasoning, I guess we should just shut down all US medical schools and import all our doctors from elsewhere - after all, they're so much better than the US MDs and DOs we train now. Fortunately for the rest of us, the logic of people like yourself is completely wrong.

 

[CDI]

There is this ongoing perception that every single FMG that applies to US residencies is some brilliant superstar applicant who would make William Osler himself proud. This perception is rubbish. There are many, many FMGs that apply with weak stats, and until fairly recently many of them actually did match. Furthermore, many of the FMGs who do match are really nothing special clinically (and yes, I've dealt with quite a number of them between med school and residency).

Secondly, there is certainly a cultural factor that you're overlooking. There is nothing surprising whatsoever about the fact that PDs prefer people who are familiar with/fluent in the US cultural milieu. Many PDs have been burned by FMGs who looked great on paper but turned out to be arrogant, uncooperative douchebags in person.

By your reasoning, I guess we should just shut down all US medical schools and import all our doctors from elsewhere - after all, they're so much better than the US MDs and DOs we train now. Fortunately for the rest of us, the logic of people like yourself is completely wrong.

You'd be right...if you ignore where I mentioned multiple times how we're talking about the bottom tier 5% AMGs vs. top 5% of IMGs.

No one has suggested or has any misconception that every IMG is a superstar applicant. Quit spewing.

Problem with this thread is SDN bias, its filled with AMGs who have no idea what goes on at the crapper community programs and are just shooting in the dark on something they clearly don't know about and will never deal with.

 

[DoctwoB]

You'd be right...if you ignore where I mentioned multiple times how we're talking about the bottom tier 5% AMGs vs. top 5% of IMGs.

You're missing Law2Doc's point though. With US grad numbers increasing, instead of choosing between a bottom of the barrel AMG vs. an IMG, they are now choosing between a 3rd-4th quintile AMG and that same IMG. All the spots better then this program have gotten more competitive, pushing down more competitive AMGs into this hypothetical spot.

 

[Doctor Bob]

Problem with this thread is SDN bias, its filled with AMGs who have no idea what goes on at the crapper community programs and are just shooting in the dark on something they clearly don't know about and will never deal with.

<shrug>
I like to think that I know what I'm talking about... I may be wrong but who knows...

Even at the "crapper community programs" there is increasing pressure to allocate spots to AMGs... IMGs still get spots there because of the disparity in scores amongst applicants. The top 5% of IMG applicants will continue to be able to find spots for a while because it's easy to resist political pressure when you can point to objective evidence that the person you are accepting is significantly better than the other applicants.

But... there will come a point where the numbers balance (AMG applicants and residency spots). At that point the political pressure will start to build (it already does at various levels and in various ways) to make sure that federal tax dollars are spent on US grads. Programs that don't pay their residents from federal funds? Well they'll be able to continue on doing whatever they want.

 

[CDI]

You're missing Law2Doc's point though. With US grad numbers increasing, instead of choosing between a bottom of the barrel AMG vs. an IMG, they are now choosing between a 3rd-4th quintile AMG and that same IMG. All the spots better then this program have gotten more competitive, pushing down more competitive AMGs into this hypothetical spot.

I certainly acknowledge that point, however even in the last year, the numbers all increased, iirc. I knows it's supposed to catch up by 2015, but there's always going to be a handful of AMGs in that low-mid tier who have $300k+ in loans and 210-230 scores who apply to competitive specialties and get burned, as many did this year. You can't just 'push them down' they have to accept getting pushed down.

Primary care PDs also don't want people who are using their programs as backups. Getting these applicants to apply, interview and rank low tier primary care programs, as a safety, is going to take some time & effort.

Now at that point you'd be right, the 'need' for IMGs is gone...but unless PDs are going to actually hold spots for the SOAP, IMGs will still be used to fill them up on the rank list.

 

[CDI]

Once we have a year where a fair number of AMGs dont match, its done and we'll end up with a system similar to Canada; there is too much money invested in educating AMGs to let them not have residencies and the governments stomach to increase spending for med ed is slim. All AMGs will match and scramble and then and only then will spots open to FMGs/IMGs. There was a time when the FMG was a necessity and was and is a huge part of american medicine. Though I am an AMG, my parents were FMGs and so I understand the importance. That being said, the time of FMGs having the access they have even now is closing. And the reality is it makes sense; there is no qid pro quo, AMGs can't go to countries FMGs train and readily get residencies so when we had a need FMGs were great but now that we don't, we don't need to allow them into the pool anymore.

I think NRMPs quick-fix to this problem was to eliminate the pre-match spots that were getting filled up by IMGs by implementing the All-In/All-Out policy. And yet even then, a few programs are still All-Out for this upcoming year and won't rank or get a single AMG.

Should have already changed if that was the case. Plenty of AMGs went SOAP this year, and not all got spots if the numbers are correct.

Wonder what would happen to the ECFMG. I guess they'd lose tons of money, jobs, etc...as IMGs apply to other countries instead.

 

[mycatishuge]

This is an idiotic ramble. Many community programs that until last year were IMG mills are now AMG predominant. IMGs are not 'the cream'. 'They are by no measure 'the smartest' - they are well-off kids who can afford to do this. I don't know which country you are from, but most IMGs I have known are not from their countries' top institutions. Instead, they are from private, for-profit schools. Besides, no matter how bright someone is, they will struggle in a new medical system. I hope you know that selection to medical schools in this country is so strict and unlike overseas, everyone can't open a medical school in their back yard, that those graduating from these institutions are fairly capable physicians.

 

[Law2Doc]

I think NRMPs quick-fix to this problem was to eliminate the pre-match spots that were getting filled up by IMGs by implementing the All-In/All-Out policy. And yet even then, a few programs are still All-Out for this upcoming year and won't rank or get a single AMG.

Should have already changed if that was the case...

Where have you been? -- it actually did start to change this past year, although the data is perhaps difficult to analyze because programs outside the match didn't historically report data collectively. But based on match spot numbers and from what most of us see, a big chunk of the community places went "all in" to the match this year. Prematch is essentially gone except for a very regional smattering -- expect this to dwindle to nonexistent in a year. More IMGs entered the match than ever, and yes they got more total match spots than previously, but the gains are illusory as they netted nothing close to the number of spots that they used to have via prematch. So they basically lost 100% of prematch spots just to increase a few percent in match spots. Meanwhile the same 93-94% of US allo grads matched as they always do, which should be very concerning for IMGs as there are many more US allo grads this year, so 93% actually means more spots than it did last year. So that basiclly means US grads were taking some additional spots they hadnt historically taken. Not to mention that SOAP was a huge disadvantage to IMGs compared to the scramble -- it's curious that you point to AMGs struggling in SOAP because they clearly had the upper hand in this system no matter what barometer you use. Yes some on SDN had issues, but actually fewer than historically. The scramble gave IMGs a more even playing field at the expense of AMGs -- if you could get your CV in before the fax machine crashed you used to be golden. SOAP fixes this.

A lot of what you are posting seems to be what you want (need?) to be true rather than what is actually happening in the trenches. I'm sure it will work out fine for you but that doesn't really change what we are saying.

 

[CDI]

Where have you been? -- it actually did start to change this past year, although the data is perhaps difficult to analyze because programs outside the match didn't historically report data collectively. But based on match spot numbers and from what most of us see, a big chunk of the community places went "all in" to the match this year. Prematch is essentially gone except for a very regional smattering -- expect this to dwindle to nonexistent in a year. More IMGs entered the match than ever, and yes they got more total match spots than previously, but the gains are illusory as they netted nothing close to the number of spots that they used to have via prematch. So they basically lost 100% of prematch spots just to increase a few percent in match spots. Meanwhile the same 93-94% of US allo grads matched as they always do, which should be very concerning for IMGs as there are many more US allo grads this year, so 93% actually means more spots than it did last year. So that basiclly means US grads were taking some additional spots they hadnt historically taken. Not to mention that SOAP was a huge disadvantage to IMGs compared to the scramble -- it's curious that you point to AMGs struggling in SOAP because they clearly had the upper hand in this system no matter what barometer you use. Yes some on SDN had issues, but actually fewer than historically. The scramble gave IMGs a more even playing field at the expense of AMGs -- if you could get your CV in before the fax machine crashed you used to be golden. SOAP fixes this.

A lot of what you are posting seems to be what you want (need?) to be true rather than what is actually happening in the trenches. I'm sure it will work out fine for you but that doesn't really change what we are saying.

This is what I don't get, ppl who have no idea what really goes on in the (IMG) "trenches" talking as if you they do.

You're trying to logic your way through a topic which probably doesn't even affect you, and never will. Where as I'm talking based on my info from a current PD, and a former PD at another of these IMG heavy programs. I even found out how many spots they went down their rank order list to fill it and still went practically all IMG this past year.

 

[Silent Cool]

No.

Lets be clear. The question wasn't, "Should you become an IMG even if you have a chance to be a US medical graduate?"

The question was, "will the day ever come when the US will no longer be reliant on IMG's? Or do you think there will always be space for img's"?

Considering a significant number of IMGs have always been able to gain access through primary care specialties, you would expect that to continue as tens of millions of people without access to insurance, get it, and start needing primary care doctors when there is already a shortage and the US has made no preparations to train more.

In other words, if you are an IMG in the future, you'll be more in demand in the US than you are now. That is not to say that as an IMG you'll be in more demand than a US grad, because you won't be. It's two entirely different issues.

As a group, IMGs which always be more willing to go into primary care than an American grad with $300,000 in student loan debt. Such graduates have tended always to gravitate more towards higher paid specialties than primary care, which is why we have a glut of the former and a shortage of the latter.

The mistake you are making here is assuming that residency spots (in ANY field) will actually exist for FMG/IMGs. At the current rate, the number of U.S. medical spots will eventually equal the number of U.S. residency spots. American grads--MD or DO--will always be preferentially chosen by PDs over IMGs. The reason that there is any "demand" (if you can call it that....it's more like a "willingness to settle") for IMGs is that there aren't enough American grads--MD or DO--to fill all of the spots. That will likely change in the near future such that U.S. med school spots will ~ U.S. residency spots.

 

[Silent Cool]

Working at a hospital is very political -- PDs get to where they are because they know how to work the politics and keep their Chirmn/Deans/administrators/trustees happy. It has less to do with competence or logic. And nobody outside of the PDs office ever sees the Step 1 scores. (I'm going to ignore your extremes because few PDs are ever actually are forced to decide between an AMG who failed versus an IMG with 260. Most of the time it's more like an AMG with 200 versus an IMG with 230. And it's rarely a one dimensional binary analysis based just on Step 1 scores, which, while used as an initial hurdle, are universally agreed not to be a useful measure of how good a resident someone will be). And yes the AMG will win these analysis, even if his stats are lower, because when the PD shows his list of residents to his bosses, and he will, they don't include these stats, just where they graduated from. The guy from U of State X looks better than the guy from some program the Chairman has never heard of. I think you are imagining a situation where the PD has unfettered authority to do whatever he wants without any bosses input or oversight, but those situations tend not to exist. He may have a long, sometimes imperceptible leash, but it's still there and if the PD objectively doesn't do a good job, and cow tow to the politicos, the leash tightens and the department head will give the job to someone else.

As I've stated in other threads, the analysis has little to do with quality. Rather it's about brand. In the US the AMGs are the trusted brand. The LCME ensures this by making US grads and schools jump through various hoops. Foreign grads, though they may have better stats don't come with this warranty. When you go to Best Buy to get a new TV, you might narrow your choices down to a Sony or some brand you never heard of that seems to have more bells and whistles for the same price. Guess what -- most people are still going to buy the Sony. Doesn't matter if it's the best or the best deal. You've heard of it. You know at you are getting. And this is the hurdle all IMG/FMGs face. Nobody cares if you have better Step 1 scores. PDs want to be able to hand a list of matched residents and their med schools to their bosses with lots of Sonys. That's how they keep their bosses happy. That's how they stay on the long leash. And in the end that's a more important motivator to them than offering a helping hand to someone outside this increasingly closed system.

And that's why you should say F*** academia and enter private practice....

 

[Law2Doc]

And that's why you should say F*** academia and enter private practice....

There are politics in private practices as well, unless you work for yourself.

 

[Law2Doc]

This is what I don't get, ppl who have no idea what really goes on in the (IMG) "trenches" talking as if you they do.

You're trying to logic your way through a topic which probably doesn't even affect you, and never will. Where as I'm talking based on my info from a current PD, and a former PD at another of these IMG heavy programs. I even found out how many spots they went down their rank order list to fill it and still went practically all IMG this past year.

The residents and attendings on this thread have more exposure to the process than you give us credit - it's not just trying to "logic our way". But if you have an inside relationship with a specific community PD, milk it for all it's worth -- not so much for the information he's telling you, but for a spot. You are making this thread too personal and what's happening nationally may or may not affect your individual plight.

Nationally US med school numbers have gone up, residency slots haven't. US match rates have been steady.The "all in" rule has taken effect, and SOAP is more US friendly than the scramble had been. so US grads are taking spots they hadnt previously, both in the match and after. Proving that most PDs arent behaving the way you are suggesting.

 

[Doctor Bob]

Where as I'm talking based on my info from a current PD, and a former PD at another of these IMG heavy programs. I even found out how many spots they went down their rank order list to fill it and still went practically all IMG this past year.

That's nice.
That's one (or two?) program(s).

The original question was asking for a more macroview of the IMG matching chances in the future. Yes, there will always be anecdotal stories about single programs, but the general -trend- is moving against IMGs.

This trend will have little bearing on a stellar applicant from.. say.. the Royal College of Surgeons in Ireland.
It will still affect a stellar applicant from... say... American University of the Carribean. The AUC applicant will still stand a chance though. The other 99% of the people in their class will be S.O.L.

 

[CDI]

That's nice.
That's one (or two?) program(s).

The original question was asking for a more macroview of the IMG matching chances in the future. Yes, there will always be anecdotal stories about single programs, but the general -trend- is moving against IMGs.

This trend will have little bearing on a stellar applicant from.. say.. the Royal College of Surgeons in Ireland.
It will still affect a stellar applicant from... say... American University of the Carribean. The AUC applicant will still stand a chance though. The other 99% of the people in their class will be S.O.L.

Its 2 distinct programs. My relative applied to both and also a third (via connections) and they were ranked by the PDs at all 3, that's why we know how far down the list they went.

 

[Doctor Bob]

Its 2 distinct programs. My relative applied to both and also a third (via connections) and they were ranked by the PDs at all 3, that's why we know how far down the list they went.

I'm not sure how that tells you how far down the list they went.
Even so, how far down a list a program goes is also a function of how the people on their list ranked them and other programs.

But that's neither here nor there.

That is still a very small fraction of the total number of programs in the country and not indicative of the overall trend. I am not saying I am speaking for the n-3 other programs in the country, but I am speaking as an APD (although I'm not really sure how much that is worth...) and programs do like to talk with each other.

Perhaps there's some speciality-dependent factors here as well. Who knows.

 

[CDI]

I'm not sure how that tells you how far down the list they went.
Even so, how far down a list a program goes is also a function of how the people on their list ranked them and other programs.

But that's neither here nor there.

That is still a very small fraction of the total number of programs in the country and not indicative of the overall trend. I am not saying I am speaking for the n-3 other programs in the country, but I am speaking as an APD (although I'm not really sure how much that is worth...) and programs do like to talk with each other.

Perhaps there's some speciality-dependent factors here as well. Who knows.

Oh sorry, I mean they actually let us know after the match how far down the list they went to fill all their spots. (One had spots left for the SOAP)

 

[CDI]

Does anyone here really believe that the AAMC power elite is going to stand by and let significant numbers of AMGs go unmatched?
They will use their money and lobbying power to have IMGs locked out of the initial match within 5 years. The IMGs have no lobbying group to match the AAMC.
Take it to the bank.

The same lobbying power that can't get us more residency spots and also keeps increasing tuitions to ridiculous amounts, everywhere? Or the one in cahoots with AMA who are letting DNPs, PAs, and insurance companies take us to the cleaners?

My solution, although real extreme, would be to charge a tuition on residency spots for IMGs, and only have these spots available in rural areas.

 

[Law2Doc]

The same lobbying power that can't get us more residency spots and also keeps increasing tuitions to ridiculous amounts, everywhere? Or the one in cahoots with AMA who are letting DNPs, PAs, and insurance companies take us to the cleaners?

My solution, although real extreme, would be to charge a tuition on residency spots for IMGs, and only have these spots available in rural areas.

It's different organizations in charge of med schools and residencies. The AAMC really has nothing to do with residency spots, and im not really sure its to their benefit to increase spots until the number of US grads starts to spproximate the number of spots anyhow. So I expect their lobbying on this issue is somewhat uninspired -- they say all the right things but don't back them up, by design. Also more residencies costs the taxpayers more $, so it's not one politicians are rushing to embrace right now.

While your solution is an interesting one, it creates a slippery slope, where programs stop preferring US grads in favor of the highest bidder. So I suspect this will never be allowed. There have been controversies in the past where people and offshore schools tried to buy residency slots; these attempts came for naught.

 

[CDI]

It's different organizations in charge of med schools and residencies. The AAMC really has nothing to do with residency spots, and im not really sure its to their benefit to increase spots until the number of US grads starts to spproximate the number of spots anyhow. So I expect their lobbying on this issue is somewhat uninspired -- they say all the right things but don't back them up, by design. Also more residencies costs the taxpayers more $, so it's not one politicians are rushing to embrace right now.

While your solution is an interesting one, it creates a slippery slope, where programs stop preferring US grads in favor of the highest bidder. So I suspect this will never be allowed. There have been controversies in the past where people and offshore schools tried to buy residency slots; these attempts came for naught.

My solution includes a clause in that there are reserved pre-set IMG spots (all costing the same amount, no bidding) for every certain number of AMG reserved spots.

Equal the scales, charge IMGs the cost of a AMG salary. No money from tax payers, only money from abroad or "residency loans". Win win.

 

[deleted109597]

My solution includes a clause in that there are reserved pre-set IMG spots (all costing the same amount, no bidding) for every certain number of AMG reserved spots.

Equal the scales, charge IMGs the cost of a AMG salary. No money from tax payers, only money from abroad or "residency loans". Win win.

My solution involves the countries that these people train in allow them to do residency there.
I can't go practice in Germany. It's tough for my wife to do it in Australia. We both did school and residency in the US. Just because we have one of the highest incomes worldwide for physicians doesn't mean we need to have dedicated spots for IMGs. We don't have a physician number access problem, we have a physician access geography problem (which you noted at one point).

 

[Law2Doc]

My solution includes a clause in that there are reserved pre-set IMG spots (all costing the same amount, no bidding) for every certain number of AMG reserved spots.

Equal the scales, charge IMGs the cost of a AMG salary. No money from tax payers, only money from abroad or "residency loans". Win win.

Why would we ever do that??? The goal in the US isn't to give equal access to IMGs. If they fill a current demand we cant fulfill domestically that's fine, but to arbitrarily protect a set of jobs for IMGs beyond that is pretty ludicrous. There is no reason for us to "equal the scales" and an enormous list of reasons why the US should not. You have to realize that the US is already extremely generous in giving not US educated spots at all -- most countries won't. over time as US schools ultimately fulfill US needs there becomes no reason to take any more IMGs and so frankly we want no reason, contractual or otherwise, to feel obligated to take more.

Again, I get why you want this to be the case, but if you could step outside of your own interests, you would see that this notion sounds pretty wacky to most of us, and will never ever happen.

 

[Brigade4Radiant]

The same lobbying power that can't get us more residency spots and also keeps increasing tuitions to ridiculous amounts, everywhere? Or the one in cahoots with AMA who are letting DNPs, PAs, and insurance companies take us to the cleaners?

My solution, although real extreme, would be to charge a tuition on residency spots for IMGs, and only have these spots available in rural areas.

Residency spots have been increasing look at NRMP IM, FM EM are all good examples an increase of 5% every year. It is the competitive specialties like derm which are holding their numbers steady and with good reason.